DPI™ (Dramatic Performance Improvement) Collaborative

Dramatic Performance Improvement: Overview

The objective of the Coleman Associates Dramatic Performance Improvement™ approach is to find new ways of working that improve productivity (i.e., the capacity to see patients), increase patient access, reduce patient waiting time, develop teamwork, improve staff satisfaction, develop patient-centered medical homes, improve patient experience and optimize the use of technology wisely. The DPI™ program is a cutting-edge collaborative training approach that teaches best practices of work processes.

To improve the patient experience, to truly feel the affects of Patient Centered Medical Home recognition (whether you seek accreditation through JCAHO or NCQA) and to stay successful in the ever evolving and competitive health care market a clinic must provide timely and appropriate access to primary care providers for patients, facilitate continuity of care, continually reassess roles and responsibilities in the clinic workplace and improve office efficiency dramatically.

However, an ever rampant no show rate, lack of high performing patient care teams, multiple handoffs engineered between staff, silos between departments, and outmoded ways of working combined with new technology create a dis-jointed, retrofitted approach to care and leads to dramatic waits for patients—waits to both get an appointment and long waits to see their provider once they get inside the doors of the clinic on their appointed day. These experiences decrease patient satisfaction as well as health outcomes. They also dramatically decrease the efficiency and satisfaction of the staff and providers often leaving them feeling “besieged” by patients and overworked by the system.

Coleman Associates. Coleman Associates has created a methodology for dramatic improvement called DPI (Dramatic Performance Improvement)™. In fact, Coleman Associates pioneered work around Rapid Cycle Improvement work in 2004 in a major public hospital system in New York. Our DPI™ program combines the best of our process efficiency concepts (the industry standard for process improvement PVR™ or Patient Visit Redesign™) with our very popular access methodology (PCS or Patient Centered Scheduling) (our practical hands on approach to Open Access or Advanced Access work). Coleman Associates has a reputation for bringing evidenced-based solutions to community health clinics across the country. Our systems are practical and produce immediate results. We can be versatile and adaptable because our methodology is well honed and because we have practical experience improving these very processes in clinics where we have worked as front lines workers. We know the real rubber meets the road difficulties that clinic staff face daily. We’ve walked a mile in their shoes.

Our Training Programs. Our learning collaboratives are a dynamic and refreshing approach to learning. We combine creativity, best practices, and well-honed concepts for improving care and efficiency. Our didactic segments are paired with active huddles to ensure adoption rather than mere discussion of ideas. Our coaching program provides structure and accountability as well as outside momentum to make these changes happen on a short timeframe.

Our training produces results in both numbers and in experience of staff and patients. Most clinics after going through our training programs reduce No Show rates dramatically--even down to the single digits. They increase access by finding more same day capacity and reducing weekly or month long waits to see providers. Once the patients more readily get in for an appointment, many of our trained clinics teams realize Cycle Times reductions of 33 to 50% -- top quartile teams reduce even further. This streamlined way of working allows for greater patient and staff satisfaction and allows patient care teams to see their patients more readily and in a way that feels less chaotic while being more efficient. The patient experience improvement that is heard and felt is a sure result of improved processes.

Our method has “magic” to it because we train the internal DPI™ team to focus like a laser beam on the needs of patients. And this focus ignites a passion for patient care that most staff members initially brought to their jobs but often have lost over time. Team members put their own needs aside and openly work together to create a patient experience that is truly satisfying. The DPI™ work becomes intensely serious and exciting. And, this is why our method works.

Read our article designed to address four myths associated with DPI™, clarify the intention of the program, and—hopefully—put your mind at ease as your practice embraces change.

Commitment

Our team works directly with sites and managers using our Coleman Team Selection Methodology and Advisory to select teams of pilot staff from each site (5 – 6 team multi-disciplinary staff) to attend trainings and develop process prototypes – in essence lead the charge at each site.

These staff members are not the only ones trained in the methodology, but they are the first among peers. This allows the organization to gain training in a time efficient manner and it allows the organization time to adapt to change and try out the new ideas.

To try out new ideas we use an accelerated PDSA model, called Rapid Redesign Testing (sometimes called by others as rapid cycle or rapid improvement testing). Our rapid cycle testing process was born out of our Patient Visit Redesign™ training program and it gives staff an opportunity to test ideas on a small scale, prove to themselves that the ideas will produce results, and then we train and coach you through rolling out of these tested ideas across the pilot sites.

To see real gains, the organization must commit a lead team that will stay the course and learn the Coleman methodology. This team must be given time and permission to create and test a new transformed visit process. A transformed patient experience means easy access to care, minimal waiting time during visits, and a significant drop in clinical errors (i.e., patient safety).

A transformed workplace is an exciting place to work where learning is optimal, teamwork the norm, and everyone can work to her/his full potential. And, a transformed organization is optimally productive, financially healthy, technologically savvy, and hierarchically flat. Such an organization adapts quickly and well to change. Getting to this place can sometimes create organizational discomfort as old ways are discarded or altered to make way for the future.

Conceptually our redesign methodology “lays the tracks for your train of change” and our trainers make sure your train arrives at the right destination on time. In doing this, we work closely with top managers and your redesign team typically comprised of five prized staff members eager for serious change. The training and implementation program spans seven months.

If this is why our method works, exactly how does it work?

The Twelve Key Milestones in our DPI™ Collaborative program are as follows:

1.Top managers sincerely and genuinely commit to DPI™ process. This means saying publicly: “Failure in this DPI Transformation is not an option. Period.” There can be no handoff from top to middle management for the responsibility of this project, or wavering of commitment.

2.When feasible, Coleman Associates conducts a half-day in-personLeadership Conference to open dialogue between top and middle managers about the DPI™ project. During this session the timeline is shared and goals for the project are set and a communication plan is established.

3.Following the Leadership Conference, five stellar staff are selected for the DPI team. We will coach you to choose the best team possible. We will let you select only staff members who eagerly embrace change. Teams are a mix of managers and line staff.

4.Top management guarantees the DPI team members an average of three hours per week “offline” from regular responsibilities to do DPI work for the entire duration of the program. Teams typically meet twice a week for testing and planning.

5.Your team members will be coached to observe and track patient visits directly. This allows a true understanding the current visit process. This exercise is not only relatively fast, it is also magnificently insightful.

6.Learning Session One (LS1), 1 day. Coleman Associates will teach your teams to dissect the current patient visit process and learn nationally tested best practices that will allow for ease of tailoring and transitioning into new systems. Teams will learn the foundational steps for opening the funnel of access to care and helping patients to secure an appointment when needed.

7.During the eight-week Learning Action Period One (LAP1) that follows Learning Session One (LS1), your teams will conduct Test Clinics (ranging from three to four hours per test). The testing methodology works amazingly well. Patients will be thrilled with “the new way” and let you know it. Each team is actively coached.

8.Learning Session Two (LS2), 1 day. Teams learn how to ratchet up both their access and their efficiency models to become more sophisticated and nuanced in their approach. They also learn how to roll out successful components of their model through training and coaching other staff while they continue to pilot and build upon this foundation. Teams learn techniques to train and coach other staff in DPI concepts.

9.Teams then embark on an eight-week Learning Action Period Two (LAP2). During this action period they will test more advanced techniques used by clinics across the country to sustain and amp up not only access to appointments but also access to their own provider with a focus on robust preparation and care coordination.

10.Learning Session Three (LS3), 1 day. Teams and trainers meet to troubleshoot and share. Teams learn how to finalize their tested ideas and link them all tightly together within each patient care team. Teams work with management to secure a green light for full scale implementation, how to integrate in central services, and how to coach others for sustained performance.

11.Teams then embark on the final six to eight-week Learning Action Period Three (LAP3). During this LAP, your team will begin using a tailored dashboard to help it monitor the new way of working and watch for consistency of access, financial viability and quality of care measures.

12.Teams and managers reunite at a capstone one-day Learning Session Four (LS4). They learn how to sustain the momentum of implementation and troubleshoot problems.

Frequently Asked Questions

1. How is this DPI collaboration approach different from a Rapid DPI?
While the Rapid DPI happens at your clinic site while patients are being seen, the DPI™ collaborative approach pulls a key team of staff members out of clinic to take time away from the hustle and bustle and learn the concepts and best practices of other centers like themselves and then create their own plan for testing and implementing (with expert advice and coaching guidance all along the way). This process is slower than the Coleman Rapid DPI, costs about half the price and teaches more of the DPI and Quality Improvement theory along the way.

2. How do we decide whether the Rapid DPI or the DPI Collaborative is a better fit for us?
There are many things to consider when deciding between the two options including timeline and urgency for change, openness for change, the size of your organization and budget. The Rapid DPI is not for the faint of heart, it is more labor intensive, costs more and yet if it's what you need...it makes change happen almost immediately. Top leadership must be fully supportive to make a Rapid DPI™ successful.

The DPI™ collaborative is ideal for organizations with more than two distinct clinic sites. It is slower, gives more staff time to “kick the tires” regarding change, helps to develop standardized processes across the organization and creates more of an internal R & D (Research and development) team. Collaboratives are most successful when there are three or more peer clinics in your organization being trained simultaneously as it fosters a sense of internal support and competition—healthy competition in which the patient is the clear winner.

In the Before you Get Started section of this website, you will find a tool to help you assess your Rapid DPI™ readiness.

3. How will the DPI process help with with Value Based Payment Changes?

DPI™ teaches your staff, managers and Patient Care Teams how to focus on the needs of the patients and optimize the visit. It will even teach your team members how to call into question whether or not the visit, in its traditional sense, is even needed by the patient or the provider. In the evolving world of payment reform, it is now not just in the interest of the patients time and needs but also in the interest of the practices finances to think about alternative ways to meet the patients medical needs without requiring them to come in for a traditional visit. DPI™ will help your team to explore those options and think about how visit workflows will best meet everyone's needs.

4. We are already recognized as a Patient Centered Medical Home (PCMH). How will DPI™ help us?

PCMH recognition is a checkbox approach to ensuring that certain procedures and steps are in place in the clinic. However, PCMH recognition does not ensure that the patients will be cared for like family. PCMH recognition neither creates the opportunity nor the necessary support to have truly self-managing teams that work at the top of their license and meet all the varied needs of the patients. DPI helps you to create a transformed experience that is fully compatible with a PCMH model.

If you are working toward PCMH recognition, our trainers are well versed in the components of PCMH and as we help you to create better processes, we will point out to you opportunities to leverage your new processes and data points to help you in your PCMH recognition process.

5. Our providers are already accustomed to having a personal medical assistant, will this make it harder for them to accept working in the full blown team model that you present?
It depends on the traits of the individual clinician. Some are team players and some are not. Patient care teams include clinicians but they are patient-centered rather than clinician-focused, as in a system of clinicians and clinical assistants. This is a whole new way of working for clinicians and non-clinicians alike. An ideal care team includes providers, MAs, front office staff as well as other support staff like nurses, behavioral health specialists, phone staff, and/or community health workers when they are already part of your mission and staffing model.

6. We aren't in agreement about whether we need to add more staff, will DPI help us make that decision?
We see a variety of staffing models. Our job is to help you maximize your current staff. We often meet organizations when staff and managers believe that staffing will solve their problems and patchwork processes have created extra work and work-arounds. After evaluating, testing and implementing new ideas, our clients often find that staff were tied up doing things that can be done is a smarter way or at a different time to help relieve some of the burden the used to feel.

7. What are the criteria used to select the DPI™ team?
Choosing the best and brightest staff to initially design and test ideas is crucial to dramatic transformation. No staff member should be excluded from consideration. We are looking for people who possess the characteristics of successful DPI team members: Great communicators, terrific team players, proven problem solvers, and embracers of change and new technology. DO NOT SELECT YOUR TEAM WITHOUT OUR COACHING YOU THROUGH THIS PROCESS.

8. What is this Tactical Nurse™ role I keep hearing about?

With improved access comes a change in triage and other team member functions, which frees up nurses to work with greater agility on the floor with the patient care team. This allows for increased clinician support and further allowing all team members to work at the top of their license. Part of our collaborative process includes an optional (depending on the progress made in other areas of team based care and access) Tactical Nurse Training. This is a dedicated session with nurses and key providers (typically in LAP2), which provides training for clinic nurses so that this role become integrated into the team and allows all nursing staff to work at the top of their license.

9. What should we expect as Return on Investment (ROI)?
The organization has a different budget structure, but every organization gains much in team based care, greatly enhanced coordination and often long overdue role clarification, increased staff engagement, provider and patient satisfaction--none of which are directly quantifiable.

Different organizations we work with share with us their deceased no shows, maximization of the schedule and increased productivity gains--the most direct route to $$ in today's market. They also share with us their savings on provider /staff retention, their decreased overtime savings and their increased visit numbers overall.

10. What does this DPI collaboration program cost?
The organization commits to giving that pilot team time off-line to do the work of the DPI collaborative. Teams get very creative about when and how they meet so the cost varies per organization based upon the cost of the team members time. The DPI™ collaborative pricing is $26,160 - $32,340 per clinic site depending on the number of sites to be trained, the travel location cost rating, and the infrastructure complexity of the organization. This is a complete cost and includes all consultant travel expenses and training materials. Please call 303.499.2058 or email for more information.

The Indispensable MA

The Indispensable Medical Assistant (MA) is an integral part of the Patient Care Team. Medical Assistants provide vital support to the care team and are a key component of Medical Homes and Team-Based Care.

The evolving role of Medical Assistants means that they do so much more than just take vitals and room patients; they participate in operational improvements for the Patient Care Team utilizing best practices to reduce the No-Show rate, perform Visit Preparation prior to the appointment, and actively manage the schedule in order to optimize access for all patients and help keep the Care Team coordinated. The MA is a support to the entire care team as they conduct a Robust Intake, the Midway Knock and participate actively in the Patient Care Team Huddle. MAs are focused on customer service as a result of the Patient Centric culture that they promote. They work to enhance continuity of care, and help make real time decisions about visit agenda-setting; they also Red-Carpet the patients. The MA has a relationship with both the patients and the Patient Care Team that is exciting, engaging and relevant to the care of every patient.

The Coleman Associates Medical Assistant (MA) Training Workshop Series teaches Medical Assistants the tactics tested and proven to enhance the patient experience and the MA/Provider partnership. The training offers a variety of training methods for adult learners such as interactive role-playing and practice sessions in smaller breakout groups. This is a hands-on training tailored to suit the needs of the health center and its existing infrastructure.

Coleman Associates partners with you to provide EHR-specific instructions for visit preparation and active schedule management. Coleman Associates will work with you to gather this information in the form of screenshots from your electronic health record as well as specific tools you may already be using. This practical and specific content will send the MAs immediately back to the health center ready to deploy the tactics and tools they just learned.

This training is geared towards MAs (or other clinical support staff such as LVNs) who are working in a team-based care setting. This training is ideal for clients who have gone through the DPI Collaborative and are ready to ensure that there is a formalized and consistent MA training to optimally support the clinician and to provide efficient quality visits for their patients.

Participants in the MA training will learn the following techniques over the course of two full training days in order to communicate more effectively with the provider, tee up their patients for their clinician and provide a truly patient-centered medical home visit:

Visit Preparation: How to effectively prepare the office (and sometime the patient) for their visit by reviewing the chart and gaps in knowledge or care.

Robust Confirmation Calls: How to conduct helpful and robust calls in advance of the appointment to facilitate a meaningful preparation for the patient visit

Patient Care Team Huddle: How to conduct and lead an effective huddle

Red Carpeting: how to provide patients with the warmest welcome and introduction to their patient visit

Robust Intake and Agenda-Setting: How to gather sufficient information from the patient to better inform the 30-second report and help the provider prepare to most effectively meet the patient’s needs.

The 30-Second Report: How to deliver an effective and succinct 30-second download to a provider about the patient who is behind the exam room door

The Midway Knock: How to provide a structured check in for the clinician midway through the visit

Active Schedule Management: How to respond to late patients, early patients and manage the schedule in order to guide the provider and reduce the chance of missed opportunities (any appointment slots where a chance to see a patient is missed)

The cost of the MA Training starts at $16,800 and it is tailored to you're your organizational goals and requirements around number of participants, days of training and amount of follow up coaching and support needed.

Rapid DPI™

Rapid Dramatic Performance Improvement™

Implement radical change with our Rapid DPI™ (Dramatic Performance Improvement) and move your organization closer to a Patient Centered Medical (Health) Home within four days? Absolutely! Our Rapid DPI™ interventions are brief and intense. Over the course of four days, a Coleman Associates training team of three to five associates works shoulder-to-shoulder with your staff, at your own site, radically redesigning work processes while you continue seeing patients. Staff is coached aggressively during the on-site week and then over an eight-week period as they are inspired to work in new ways to better serve your patients.

Each clinic session – morning and afternoon – is an iterative test of accepted recommendations as the staff implements key new concepts. By the end of Day One, staff are re-energized as they realize dramatically improved outcomes – such as lower cycle times, better teamwork, increased patient access and ending the clinic session on time – are utterly possible. Patients notice too and appreciate the change. During a recent DPI™, one patient remarked:

“I loved my visit today – it was so fast! If all my visits were like this, I’d keep all my appointments!”

In a Rapid DPI™, we don’t have the luxury of months to change obsolete work processes. Minutes count. Hours are considerable chunks of time. Each clinic session is an opportunity to make radical changes. Each day must be transformative.

Everything seems to be happening faster and faster these days. What would happen in months years ago, we now expect to see happen in days or weeks. Many organizations are looking for ways to make rapid cycle improvements happen overnight. Our Rapid DPI™ approach makes changes happen overnight and then establishes the framework for longer lasting changes.

The Rapid DPI™ begins with four days on site, followed by two follow-up coaching visits to leverage your momentum and move the site forward. The first follow-up visit (we call this the Mid-Course Visit) brings you two associates for a 1.5 to 2-day site visit around Week 4 of the program. The second visit (the Capstone Visit) is a 1-day visit with one associate that takes place during Week 8 of the program. The best way to remember this is that Rapid DPI gives you 4 associates for 4 days, then 2 associates for 2 days and 1 associate for 1 day.

Here’s what happens when you commit to Rapid DPI™:

• Team Prep. Four weeks before coming on site the managers send Coleman Associates a short list of key information (such as a floor plan, staffing lists, etc.), and have an orientation call with the Coleman Associate lead. This allows managers to be introduced to the Rapid DPI™ Methodology and prepare for the Rapid DPI week. This is not onerous, but sets the gears in motion. The Coleman Team uses this information in their work sessions to prepare for a quick and solid start to the week.

• Day One AM.Coleman Group is on site and meets with managers in the morning to set the final stage and give an overview of the week. Then the Coleman Team goes out on the floor at the start of the clinic session and observes, ask questions, and collects data. Trainers observe staff on the job to understand the current process and build rapport. The trainers meet with the Operational Leaders at the site over a working lunch and make 3-5 complete recommendations for how to move the clinic, in the next session closer to a Patient Centered Medical Home. The Operational team discusses the recommendations and chooses whether or not to accept them (the more recommendations you accept, the more successful you will be). The remainder of the lunch hour is spent planning the implementation that afternoon.

• Day One PM.The Coleman Team returns to the clinic floor, this time with key Operational managers in order to train, coach, and implement the recommendations accepted. The Coleman Team sees the recommendations put in place and continues to work side-by-side with staff. The end of the day debriefing session is the place to share outcomes, successes, failures (should there be any) and for the Coleman Team to make an additional 3-5 recommendations to be implemented in the next clinic session.

• Day Two through Four. These days carry on just as Day One PM and the recommendations continue to build upon one another strengthening the weaker areas of the clinic. Recommendations may likely include: reducing no-show rates, improving access, decreasing messages (telephone encounters), coordinating and strengthening Patient Care Teams, implementing Patient Care Team huddles, adjusting frayed scheduling templates, improving collections, improving phone answering, or creating a tactical nurse function in the clinic by adding the nurse to the clinical team (and pulling him/her out of the outdated “triage” office). The recommendations are focused on producing dramatic results quickly...results that staff can feel and that are reflected in patient comments and patient experience surveys.

• Day Four.Trainers are onsite for the morning only. The Coleman Rapid DPI™ Team monitors progress, aids with final coaching and puts a final Performance Dashboard in place so that management and staff can monitor and see their improvements reflected in the public results each clinic session. Managers have assumed ownership for the redesign. The morning ends with a 1.5 hour Exit Conference with trainers and managers.

• Coaching Program.With such dramatic changes, it’s very unlikely that things will “go back to the old way ” on the following Monday. But to ensure your gains and to continue to move you forward, the Rapid DPI™ has an eight-week coaching period. The coaching calls/texts/emails start out with check ins a couple of times a week during the first week or two and then decrease in frequency.

• Mid-Course Coaching Visit. After four weeks of coaching, two associates come back on site for a two-day follow up. They observe, see the changes in action, and help to fine tune the new system. They make smaller recommendations that smooth any rough edges on the process. Managers and staff find this added accountability gives them an extra push to stay focused on the changes.

• Capstone Visit.At the end of the eight weeks, the coach comes on site for one final look-see. The capstone day is a day or seeing changes, reconciling data with the new patient experience, answering questions, and providing expert guidance as culture of the organization continues its shift.

Most managers tell us that this week on site generally pays for itself in increased revenue, collections and decreased expenses within the on-site week or the following week. One Clinic Manager said at the end of the eight-week Rapid DPI™ process that “Our work with the Coleman Group was nothing short of revolutionary.”

The Rapid DPI™ pricing is $45,480 to $51,820 depending on the travel location and the infrastructure complexity of the site or service area. This is a complete cost and includes all consultant travel expenses and training materials. Please call 303.499.2058 or email for more information.

DPI™ + QV2

Quality and Value are two key health care terms for the next decade. Recently, these words have been attached to job satisfaction, patient experience, employer of choice, and provider of choice; increasingly they will be associated with such phrases such as financial viability, competitive advantage, and legacy leaderships.

Improving health outcomes has been a key part of care and is one of the components of the IHI Triple Aim in health care: quality, value, and patient experience. However, when health care is provided in an outmoded way, in an outdated patient–provider dyad relationship, then provider burnout is an inevitable consequence. Thus the updated Triple Aim…the quadruple Aim.

Attempts at burnout reduction as well as initiatives to increase patient and staff engagement have fallen short. Why? Because keeping patients well is not a one-man or one-woman job. Yet the hierarchy of health care establishes an ultimate one person responsibility structure. Keeping patients well is a difficult task. In many ways, it feels like it is out of our hands as caregivers, and the continuous striving toward this unreachable goal can create burnout, frustration, and job churn. It can also causes workers to stop striving to reach a goal that always seems to be beyond reach.

Coleman Associates has built upon our methodology for DPI (Dramatic Performance Improvement)™ in a way that provides a more customized approach to making another big push in Dramatic Improvement—a push toward quality and exponential Value improvement. DPI™ + QV2 is a new track designed for successful graduates of the Coleman DPI™ program who are looking to make more significant gains in improvement. This program has been created for DPI™ graduates who are looking more intentionally forward with an eye toward payment reform: payment based on value and quality metrics versus strictly fee for service reimbursement.

DPI™ + QV2 builds upon our process efficiency concepts (the industry standard for process improvement PVR™ or Patient Visit Redesign™) with our very popular access methodology (PCS or Patient Centered Scheduling) and our Team Based, Medical Home supporting techniques taught in our DPI™ program. DPI™ + QV2 is a ten-month program that combines the most standout training features of our programs and is a hybrid of our classroom style DPI™ collaborative model and our shoulder to shoulder Rapid DPI™ model.

Once gains are made under DPI™, an organization is well positioned to work as a true Patient Centered Medical Home, and can provide better access along with a more team-based care approach to seeing patients. These changes in a competitive health care market mean that patients have better access to primary care providers. For providers, continuity of care is emphasized, roles and responsibilities in the clinic workplace are continually reassessed, and offices make data-driven decisions that continually improve efficiency.

DPI™ + QV2 provides a review and training around ten key areas of infrastructure that either support or detract from the goals of providing quality and exponential value to a patient. These ten areas include the following:

Data availability/Usability as related to Operational and Quality Improvement Management;

Clinical Quality Metrics and opportunities within the organization’s current or target population;

Accountable Care Organization and other Payor Metrics and pay for performance measures with a review of deficiencies (may include PCMH, chronic disease management, reporting, etc.);

IT and the Electronic Medical Record leveraging as well as challenges and problem-solving around charting;

Patient access (on the phone and wait for appointment) as compared to baseline and improvements realized in the DPI™ work;

Patient Care teams, including a review of co-location, anticipatory work by the care team, the roles of the MA, nurses, outreach and community health liaisons, as well as a review of absences and ongoing staffing challenges;

Referral systems and a review of the referral backlogs and processing;

Care team integration opportunities as they relate to pharmacy, dental, behavioral health and other community connections; and

Leadership development and capacity for change management, including a self-assessment around Emotional Intelligence, data driven decision-making and accountability channels.

Contact us to learn more about DPI™ + QV2 and to figure out if this program is the right choice for your organization. Pricing is similar to the DPI collaborative program from which the organization graduated and is available upon discussion and request.

Tactical Nurse™ Training

After working both as nurses and alongside nurses in community health we have had the tragic realization that most talented nurses are stuck in triage offices, coordinated care offices, and everywhere else away from the hub of the patient care team. Our Tactical Nurse™ Training is written by our experienced nurses & providers and it teaches your nurses, managers and providers practical steps for getting nurses into the Patient Care Team where they can be optimally productive and truly work at the top of their license.

Picking patients in the huddle and choosing how to focus your efforts;

Taking a great interview and understanding patient priorities;

Delivering a concise and effective nursing summary to the provider;

Determining when to finish a nurse solo visit and when to turn it over to a provider (this factors in the current protocols, visit requirements for your organization, etc.);

Documenting your nursing visit in the EMR and for billing;

The financial case for nursing support; and

Maintaining the clinic flow and your own time management.

Our Tactical Nursing Training program is a stand alone program yet can be added to a DPI collaborative, Rapid DPI program or DPI Single Team Training. As a stand alone training program the Tactical Nurse Training can be done as either a one-day intensive program or it is most effective on a longer timeline with three robust training sessions over the course of five months and Coleman coaching provided throughout this exciting transformation.

Contact us for more information on the Tactical Nurse Program.

Conference Speaking

Our dynamic speakers keep participants engaged and inspire them to learn and make change happen. Our honed training programs paired with the many best practices we see and pilot each week give us unparalleled expertise to present to your group and help them to begin to see the possibilities.

We have provided workshops and conference speakers for NACHC, AMGA, MGMA, large scale Planned Parenthood events, PCAs across the country, as well as individual organizations for staff workshops or leadership & board retreats.

Whether your group is 50 or 500 we can share our experiences and get your change started.

Participants have said:

"I enjoyed every minute of your captive and moving advice. Thank you so much for passing forward so much that can help others."

“Information was concise and relevant.”

"All the trainers were great. There was so much knowledge to gain."

"I found this conference presentation to be insightful and validating best practices in place."

"Melissa is an outstanding speaker."

“Fabulous trainer and very entertaining. The examples were excellent. This sounds like a great system for change. All my questions were answered.”

“The methods are unorthodox but that makes them great. These are changes that I can definitely apply in my facility.”

“This session alone was worth the price admission! Melissa was a very engaging speaker and I’m so excited to have attended this session!”

“This was the most engaging presentation that I have participated in during the entire conference.”

“Wonderful speaker with practical ideas that can be taken back and put into place”

“Wow! Well done, useful tips, engaging new ways to think!

“Melissa was great! She is so knowledgeable and energetic! She has me excited to take these ideas back to our clinic! She really helped me understand the importance of patient engagement”

The CHC of the Future

In our most recent conference topic, we pull together what we know about payment reform, upcoming technology integration, predicted operational improvements, clinical leadership and changing human resources to create a half-day or full-day workshop for staff and leadership. Find out today what the future holds for you and your team!

High Impact Management Program (HIMP)

Managing successful transformation and change requires skilled and nuanced management at all levels of the organization. Our High Impact Management Program (HIMP) is an inspiring and challenging journey of leadership development. This program consists of lessons, exercises and discussions around the following areas:

Goal-setting and progress monitoring,

Data-driven decision making (including using/understanding data),

Ownership and empowerment of managers,

Candor in discussions,

Leadership team building,

Honest reflection and self-awareness,

Understanding and correcting Dysfunctional Teams,

Growing and developing staff,

Leading with emotional intelligence, and

Attracting and retaining talent.

This program lays the track of change for your managers both individually and as a management team alongside the transformational program for your staff (DPI™ Collaborative or Rapid DPI™).

Our program picks up where many great management books leave off and guides management teams in developing their group strength and internalizing their goals so they can finally lead staff confidently and in unison with a true “rallying cry” for patient-centered change.

Introductory High Impact Management Program

The introductory HIMProgram is a three-month training program specifically designed for managers who have risen up from the ranks and may have minimal formal management training. When they are promoted but not given skills training or management learning, they are sometimes referred to as accidental managers. This program focuses primarily on individual growth within the context of the leadership team. The program has been reported to strengthen communication between teams (silos) and it helps to establish a common vocabulary and set of goals around how managers operate.

This program focuses on the following key areas:

Responsibility and taking ownership of what happens in your department,

Time management,

Hiring and De-hiring decision-making,

Coaching staff,

Giving constructive feedback,

Developing rising stars,

Cultivating ongoing management learning, and

Identifying & minimizing dysfunctions on your team.

The key books in this program are Monday Morning Leadership by David Cottrell and The Five Dysfunctions of a Team by Patrick Lencioni—two books we find to be extremely helpful in this stage of management development.

This introduction to High Impact Management Program is a three-month training management team development consisting of the following components: (bulleted list)

A kick off training day for management teams (conducted in-person);

A series of management books and reading materials provided to all participants;

Thoughtful homework assignments given each of the twelve weeks (which take 30 – 45 minutes each to complete);

Weekly group check in calls to discuss the homework and plan for integration of the new learning (these are done via video conference when feasible or conference phone line);

A capstone training day (provided when budget permits) allows the team to concretize learning, provides a forum for needed face to face conversations and is the time for the leadership team to establish next steps.

The cost for each of these High Impact Management Program rounds can be budgeted in the range of $21,800 – $28,600 depending on the number of in-person sessions desired and the level of coaching requested, materials needed.

Advanced High Impact Management Trainings

Coleman offers additional training for managers tailored to the needs and challenges that arose during the introductory High Impact Management Program (HIMP).

These more advance programs focus on tools and techniques to help management teams work through personnel struggles, accountability failings, conflicting goals, misunderstood personality styles, emotional intelligence variants as well as turf battles or internal politics that plague each organization.

Again, utilizing a series of workshops, conference calls, and webinars, our program leads entire management teams through this tough work to determine their true priorities, to hone their communications, and to set them up to drive for dramatic results. Results that patients AND staff can feel.

The cost for each of these High Impact Management Program rounds can be budgeted in the range of $21,800 – $28,600 depending on the number of in-person sessions desired and the level of coaching requested, materials needed.

HIMP for Executive Teams

Sometimes over the course of change management endeavors it becomes evident that some of the challenges of local managers stem from systemic problems rooted at the Executive Level. In the executive team miscommunications, unclear or inconsistent accountability decisions, general Team Dysfunctions and Emotional Intelligence gaps are more pronounced and can create a ripple effect that impacts the change processes on the front line.

HIMP for Executive Teams provides a forum for top managers to have tough and often long-needed conversations behind closed doors that allow for building and strengthening of the executive team and also provide a platform for the leadership team to look critically at the evolving healthcare landscape and consider and plan for future needs (as well as begin succession planning activities and discussions).

This program is recommended as a six-month program with three in-person half-day sessions. The sessions utilize teaching techniques to foster candid conversation. They also provide a report out from the trainers on the key issues that surfaced from front lines managers (in the introductory HIMP session) in order to provide a greater level of candor and create opportunities for the executive team to examine the challenges of the managers that report to them. This program sometimes creates organizational discomfort as top managers are encouraged to look at the sometimes disappointing, frustrating or unpleasant components of executive leadership.

The program length, individual coaching and reading components can be altered to reflect the time and budget resource considerations of the organization.

The cost for each of these High Impact Management Program rounds can be budgeted in the range of $21,800 – $28,600 depending on the number of in-person sessions desired and the level of coaching requested, materials needed.

HIMP: Meeting Effectiveness Assessment and Coaching”

Are your meetings boring? Does your organization suffer from too many meetings without enough action? Do you want your meeting culture to set the tone for your organization?

Coleman Associates has a process to help your organization make the most of your precious meeting time. Using outside influences such as Patrick Lencioni’s “Death by Meeting,” Coleman Associates has designed a 6-month workout program to transform your organizations meetings. This does not happen ‘to you’ this happens with you. By partnering with your leadership and following a new process for a meeting structure, Coleman Associates will help you develop a new custom meeting format that will revolutionize the time your organization commits to meetings.

Coleman Associates has a history of improving team dynamics through their innovative and Socratic coaching processes. They have been able to improve Team Dynamics by over 60%. (These results were quantified through a Five Dysfunctions of a Team pre and post-test administered six months apart)

An Associate will visit your organization to conduct the following transformative process:

Step 1. CA will conduct a pre-test on baseline team dynamics. Using Patrick Lencioni’s Five Dysfunctions of a Team, CA will evaluate how well your meetings are currently functioning by way of evaluating the team’s dynamics through a self-assessment.

Step 2. Coleman Associates will facilitate a team agreement on a new meeting format. An Associate will work in coordination with the organization’s meeting team after reading “Death by Meeting” to identify a new, preferable meeting format. This is an important part of CA’s process. A new meeting format will only be sustainable if it is designed and implemented with ‘buy-in’ of the staff associated with the meetings.

Step 3. Coleman Associates will facilitate the first meeting according to the new process decided upon in step 2. Coleman Associates will help the team set ground rules, set time limits, set goals and follow-up on action items.

Step 4. After a new format has been tested, Coleman Associates will come on site to train a facilitator to facilitate all future meetings. In Step 3, Coleman Associates was the facilitator. A sign of a truly successful process is when the organization can sustain the new process without outside facilitation. This is cornerstone of the Coleman Associates transformational meeting process. A post-test will be administered at this time to gauge improvement in team dynamics.

Step 5. Coleman Associates will provide distance coaching after the next meeting to ensure follow-up actions are completed and the next meeting is set-up for success.

All pre and post-test results will be shared with the organization as well as written processes for the new meeting format. These processes are user-friendly and designed so future facilitators can carry on the new meeting format for years to come!

The cost for each of these High Impact Management Program rounds can be budgeted in the range of $21,800 – $28,600 depending on the number of in-person sessions desired and the level of coaching requested, materials needed.

Performance Dashboard Program

Whether beginning a change initiative, re-evaluating your course of action in this changing environment, or return to a data-driven decision making culture, our Performance Dashboard Program helps your leadership team and staff to get back in touch with the data that should drive your change.

This program has our most broad audience. This training can be tailored for use with executive teams and boards to re-prioritize and re-establish metrics. Others use this program to engage staff in a data-driven system and data tools that will be part of a new organizational effort. Whatever your goal, we can customize our program for you to do the following:

Provide a forum for discussion and guided decision-making around data and priorities;

Provide training to create a common vocabulary around operational metrics;

Create an engagement in the data and provide initial steps for staff and local managers to take ownership of the data; and

Vroom! Online Accelerated Learning Room

Vroom Training, the Coleman Associates online accelerated Learning Room, is a platform for medical clinics and organizations who are about to embark upon or who have just completed the bulk of operational redesign and workflow transformation. These changes create a stronger, higher functioning employee and also often create a need for the following:

A robust and consistent on-boarding process for new hires;

Job role redefinition and ongoing staff development/training;

A reliable and more formalized performance review process;

A strong interface with HR to ensure updated and consistent expectations around new processes.

Vroom! provides that solution for you. Vroom! allows organizations to subscribe staff and monitor their training progress. A yearly subscription keeps best practices and key DPI™ concepts at the forefront of workflows and organizational thought.

Coleman Associates is a boutique consulting firm with a well-earned reputation for improving services by helping medical clinics redesign their work processes to make things work better for patients...and therefore staff. Often after having such a positive experience with their Coleman Trainers and Coaches, management teams ask how they can keep their staff connected to us in order to keep up their new skills, incorporate the process changes into the new evaluation structure, and onboard new staff successfully into the redesign model of care. Vroom! is an online platform available 24/7 that allows you to train, refresh, follow up and sustain the key components of the DPI model of care.

There are ten unique modules to Vroom including Effective Care Team Huddles, Robust Confirmation Calling to reduce No Shows, Red-Carpeting the Patient to increase Patient Satisfaction, Jockey-ing of the Schedule, and Operational Metrics Tutorial...just to name a few.

Each Vroom! Module consists of a pre-test, then a series of modules to review complete with tools and guides, and then a post-test. Once your staff member has successfully completed the training and demonstrated their learning through the post-test, they can print their certificate, which is suitable for their employee file. This program can serve as a reference and each user can sign in as often as they like and refresh themselves on the components of the model at anytime!

Vroom provides you the external platform to support your transformation and integrate it into your Human Resources package for a greater level of employee development. Vroom! is also available to be licensed and incorporated into your own internal Learning Management System (LMS). Contact us for a free trial, or to discuss LMS integration or Group Pricing.

Patient Visit Redesign™ Workshop

The Patient Visit Redesign™ Workshop teaches staff and managers the tactics tested and proven to improve the patient experience. “The more the merrier” is this workshop’s motto. There’s no limit to the number of participants. Staff at all levels find this training format to be as fun as it is illuminating and informative.

To accommodate your needs, the workshop can range from two to four hours in length. The longer the workshop, the more we can teach your staff about the potential and impact of Patient Visit Redesign™.

While it’s not possible to train staff and managers to successfully redesign the patient visit process within the finite scope of a single workshop, many tactics can be applied immediately to help reduce cycle time and improve productivity.

The cost of a Patient Visit Redesign™ Workshop is $5,500 to $13,800, including travel expenses and materials. The cost will vary based on workshop length and number of participants (which determines whether we use one, two or three trainers).

Participants in Patient Visit Redesign™ Workshops have said:

“Information was concise and relevant.”

“Fabulous trainer and very entertaining. The examples were excellent. This sounds like a great system for change. All my questions were answered.”

“The methods are unorthodox but that makes them great. These are changes that I can definitely apply in my facility.”

“This session alone was worth the price admission! Melissa was a very engaging speaker and I’m so excited to have attended this session!”

“This was the most engaging presentation that I have participated in during the entire conference.”

“Wonderful speaker with practical ideas that can be taken back and put into place”

“Wow! Well done, useful tips, engaging new ways to think!

“Melissa was great! She is so knowledgeable and energetic! She has me excited to take these ideas back to our clinic! She really helped me understand the importance of patient engagement”

Patient Centered Scheduling Program

We designed this program to improve patient access, increase continuity of care, and decrease days to third next available appointment. This is not the usual data-analysis-crazed IT-driven program, but rather a methodology born from our well-respected and highly successful Patient Visit Redesign™ training that gets dramatic results for clinics struggling to create access with current staff and schedules. We work with and not against providers and patient care teams in order to create the best system of access for all patients—both scheduled and walk-in, routine or acute.

National statistics indicate that seventy-five percent of patients want appointments on the same day they call. While this “demand” percentage may vary among individual clinics, the point is that when clinics are functioning at their best, patients can get in to see their providers when they want to. Patient Centered Scheduling (PCS) is about balancing the demand and supply for same-day appointments at your clinic.

The objective of Patient Centered Scheduling is to improve patient access. By focusing aggressively on reducing no-show rates, Simplified Patient Scheduling, and increasing capacity, this methodology works to accommodate a patient’s request an appointment on the day of the patient’s choosing with her/his primary care provider or provider team.

Twenty-five ambulatory care clinics from New York City’s Health and Hospitals Corporation have completed Patient Centered Scheduling. By following the PCS methodology, these clinics have:

•Decreased no-show rates by an average of 74%, with one-half of the teams achieving no-show rates of less than 10%.

•Created at least 25% more same day access (with their own provider) for those patients who want it. Forty percent of the PCS teams reached a PCS third next available goal of 5 days by the final collaborative Learning Session.

Patient complaints about the difficulty of getting appointments when they want them (access);

High no-show rates (because patients are often not given immediate access to care when they experience episodic acute problems)

Unimpressive productivity (because of high no-show rates and an inability to react quickly to maximize lost time);

High patient walk-in rates (because patients know this is the most effective way for them to deal with a flawed patient appointment system); and

Poor staff morale (because of the siege mentality generated by high walk-in rates).

It makes sense that traditional scheduling systems don’t work well: rather than being engineered to satisfy patients, they are designed by staff and managers to govern—unsuccessfully—the flow of the day. Consequently, there are often too many appointment types with each type (like “Physical” or “PAP Smear”) having a unique time allotment (i.e., 20, 30, or 45 minutes).

Magnify these problems by double-booking patients and the result will be lengthy appointment cycle times, dissatisfied patients, and highly stressed staff. Finally, combine these elements with a staff schedule that is out of alignment with patient demand and you have roller-coaster days that exhaust staff and frustrate patients.

Our Training Approach

The major components of our Patient Centered Scheduling program have been woven into our DPI program.

For organizations with extremely severe access issues, this program will be conducted specifically to tackle this issue. In these cases, our Patient Centered Scheduling collaborative will consist of five learning sessions and four Learning Action Periods (LAPs) spanning an eight-month period. The key milestones for each PCS Collaborative are:

•Learning Session Two. Focus: Forming Patient Care Teams (PCTs), Reducing Demand to Reduce Third Next Available Appointment (TNAA), Using Hidden Capacity to reduce TNAAAction Period Two. Teams begin spreading the model to two additional Patient Care Teams, evaluate Third Next Available Appointment (industry standard for metric on availability).

•Learning Session Three. Teams learn how to roll out PCS across the entire clinic, Training and Coaching PCTs, Public availability of data and Scoreboarding, Troubleshooting problemsAction Period Three. Finalize Implementation of PCS across the clinic.

•Learning Session Four. Teams learn to troubleshooting Problems and Barriers, Understanding Continuity, Final Backlog reduction, Continue Reducing Third Next Available Appointment or “TNAA” (i.e., adequate same-day appointment slots)Action Period Four. Teams continue to follow the program as they watch the third next available appointment data fall through diligence and anchor PCS changes.

The PCS program structure encourages the integration of Patient Visit Redesign™ and Patient Centered Scheduling, which is natural and synergistic combination.

Look-See

Sometimes, you just need an outsider’s perspective in order to provide clarity for your organization. After looking at the same people, processes, papers, and places day after day, you can lose those fresh eyes that allowed you to see clearly what works, what doesn’t work, and why.

That’s where the Coleman Associates Look-See comes in. The Look-See consists of inviting two or three associates to spend a couple of days with your team on-site to see, hear, listen, observe, and reconcile information using their seasoned process oriented and patient-centric eyes.

Depending on the size of your organization, the Look-See provides not only an opportunity to ask questions and begin to stir the hearts and minds of staff about the way they do work every day, but it also provides a very detailed report out to leadership about where the organization looks strongest and where it has the most room to grow. An exit conference that shares candid observations and suggests next steps, when partnered with the organizational goals and priorities, offers a starting point for many organizations, and helps to provide a trajectory and track for both short-term and long-term goals.

This multi-day, multi-associate Look-See is a consulting approach that maximizes time on-site at a clinic and makes in-the-moment suggestions to medical clinic leadership about improvements to both better the patient experience as well as increase clinic efficiency. Rather than requiring off-line time for internal staff to meet with the Coleman “consulting team,” the Coleman Associates (CA) consultants are shoulder to shoulder in the clinic with staff in real-time to observe and ask questions and/or make small recommendations. These suggestions serve to open the avenues that will allow change to begin by easing access problems, improving the patient experience, and standardizing current systems. The recommendations are the consequence of staff suggestions, on the floor observations, and CA experience in working with hundreds of sites to make Rapid Dramatic Performance Improvement™.

The CA consultants works hand in hand with the management team, meeting with the managers at the end of the two-day visit in order to share observations and information, make recommendations, identify areas most in need or most ready for improvement, and begin to lay the groundwork for a new path forward. In this session and in the final written report, the consultants will suggest timing and staging of improvement efforts (including engaging in a follow up Coleman DPI™ process), and will communicate overall goals, outcomes, and expectations related to this project.

Should the organization decide to proceed with a Rapid DPI™ program, this Look-See will serve to prepare staff, organize the leadership team, and provide guidance to senior management about changes that should be made in order to ensure that they get the most out of the Rapid DPI™ engagement.

Office Space Utilization and Remodeling

Coleman Associates have visited hundreds of health centers across the country to help with Office Space Utilization and Remodeling. Health Centers that offer services ranging from family practice, pediatrics, women’s-health, behavioral health, call-center services, dentistry, and specialty care. Not all are designed optimally in regards to EMR hardware and workflow. An efficient workflow paired with a well-designed exam room layout is the key to a patient and staff centered model. Our team optimization may not specialize in interior design, but we’ve seen what works! If you’re interested in redesigning or building out your health center, we can help!

There are three primary elements of consideration when it comes to Office Space Utilization and Remodeling of a health-center from our experience as Coleman Associates.

These are Patient-flow, Workflow and Spatial Communication.

Office Space Utilization and Remodeling: Patient Flow

The movement of patients, family, staff, information, equipment, supplies and medication must be carefully considered. The coordination and integrations of these processes can create a sense of calm by reducing the bottlenecks and chaos that is often associated with some health center settings.

For some health centers looking to improve Office Space Utilization and Remodeling, assessing and improving the dynamics of the patient visit are a good first step (Take a look at our Team Dance to see how we can help with this). For others, designing a workspace to compliment an efficient visit model may create the potential to move your practice from good to great.

Office Space Utilization and Remodeling: WorkFlow

The second element to consider is Workflow. Workflow looks at the careful and thoughtful design of both efficient and well-defined sequencing of steps in the clinical and administrative work. Creating work areas that are thoughtfully integrated with patient activities and movement can improve the quality of work and reduce delays in health care delivery. For example, the location of an exam table in relation to the exam room door is an important consideration for patient experience, privacy, and reduction of repetitious steps. Additionally, the decision to opt for a laptop-based practice vs. Thin client products vs. a full PC (Personal Computer) set up is a crucial decision for staff experience and efficiency. If administrative workload is hot topic at your center, perhaps the location of your phone operators should be too. As pricey as some technology can be, the most expensive option (nor the least expensive option) isn’t always the best one from our experience.

Office Space Utilization and Remodeling: Communication

The third element is Communication. Although EMR’s have created multiple new methods to transfer information, that doesn’t necessarily equate to efficient communication. In fact, in today's digital communication world, direct face to face observations and line of sight communication is increasingly compromised. We observe well-intended but broken communication happening much more frequently than it should. In this day of technologically aided communication--sometimes the technology isn’t always the right answer nor is it regularly implemented in the best way possible. The communication that occurs between staff and patients, or in between members of the care teams must be carefully designed to enhance direct, professional, and personal connections all while maintaining privacy.

By seeing the current iterations of each of the three elements in place at various health-centers across the country, our team can help you leverage your workspace to best suit your patients and staff in optimal care delivery.

CHAMP Program

Fuel your Inner Chispa (spark) through our CHAMP Program!

The Coleman Highly Accelerated Mentoring Program is an opportunity to work shoulder to shoulder with the Coleman Associates Chispa Team (Chispa is spark in Spanish) while we work to makeover a clinic. You will learn from a team of seasoned experts how process improvement happens, what data points are most important, how to affect change and how to build sustainable changes one upon another.

Those interested in being a CHAMP will have a deep passion for making healthcare work better, an itch for change and a toleration for long hours, active engaged debate and have some experience as a coach. The CHAMP program is a training value of $7500 with $500 of that paid as an application fee up front in order to be interviewed and scheduled at a DPI. The CHAMP program is a one-week deep immersion and all hotel, food, and training costs are included. The only cost not covered is the cost to get to the team hotel for the week.

If you have a week, we will give you a full, fun, active immersion in change and performance improvement processes.

Clients

Our clients are rural, urban, small, large, established, new, free-standing clinics, Community Health Centers, ambulatory care facilities, or social service entities… anyone who believes there is a better, more cost-effective and patient-centered way to provide care

Testimonials

We are hired by the Bureau of Primary Healthcare, NACHC, Commonwealth foundation, Blue Shield foundation, California HealthCare Foundation, Fry Foundation, Various Insurers, County health departments, Primary Care Associations, Hospital Networks, Planned Parenthood Affiliates and by clinics directly. No matter your patient base, we have worked with someone just like you